Healthcare Provider Details

I. General information

NPI: 1730297839
Provider Name (Legal Business Name): JOSHUA ABIODUN OBIRI B.SC RPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 11/18/2020
Certification Date: 11/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5958 N CANTON CENTER RD STE 300
CANTON MI
48187-2766
US

IV. Provider business mailing address

29757 WEXFORD BLVD
NOVI MI
48377-4401
US

V. Phone/Fax

Practice location:
  • Phone: 734-212-5828
  • Fax: 734-212-5827
Mailing address:
  • Phone: 313-515-6067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501005271
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: